NOTICE OF PRIVACY PRACTICES FOR
OPTIMIZED EYE CARE, PC
Optimized Eye Care P.C.
175 N. Ada St., Suite 200
Chicago, IL 60607
Contact our Privacy Officer at (773) 309-1281 or email@example.com
Updated August 31, 2015
YOUR INFORMATION. YOUR RIGHTS. OUR RESPONSIBILITIES.
This notice describes how medical information about you may be used and disclosed by Optimized Eye Care, PC ("we") and how you can get access to this information. Please review it carefully.
When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you.
Get an electronic or paper copy of your Patient Chart
Ask us to correct your Patient Chart
Request confidential communications
Ask us to limit what we use or share
Get a list of those with whom we've shared information
Get a copy of this privacy notice
You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly.
Choose someone to act for you
File a complaint if you feel your rights are violated
For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information in the situations described below, talk to us at firstname.lastname@example.org. Tell us what you want us to do, and we will follow your instructions.
In these cases, you have both the right and choice to tell us to:
In these cases we never share your information unless you give us written permission:
Our Uses and Disclosures
How do we typically use or share your health information?
We typically use or share your health information in the following ways.
We can use your health information and share it with professionals, including eye care professionals (ophthalmologist, optometrist, optician, or optical staff) who are treating you.
Example: A doctor treating you for an injury asks another doctor about your overall health condition.
Send your prescription to eye care product retailers
We can use and share your health information, including your eyewear prescription information, with qualified eye care professionals and eye care product retailers so you can obtain appropriate vision or ocular products for your care.
Example: You would like to make a purchase from a retailer of eyewear. You successfully complete Opternative’s exam and, by agreeing to the to the Service Agreement, you give us permission to send your health information, including exam status, prescription, and any other pertinent information, to the retailer for the dispensing of your corrective eyewear.
Run our organization
We can use and share your health information to run our practice, improve your care, and contact you when necessary.
Example: We use health information about you to manage your treatment and services.
Bill for your health services
We can use and share your health information to bill and get payment from health plans or other entities.
Example: We give information about you to your health insurance plan so it will pay for your services.
How else can we use or share your health information?
We are allowed or required to share your information in other ways – usually in ways that contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes. For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html.
Help with public health and safety issues
We can share health information about you for certain situations such as:
We may use or share your non-personally identifiable information for health research, such as for academic study, clinical advancements or diagnosis determination research. This research may be sold or made publicly available, but under no circumstances will it include any personally identifiable information. In addition, some research may result in the discoveries or developments of new technologies, medical devices, therapies, or treatments. In the event of any new discoveries or developments, you will have no proprietary or other ownership interest or claim for compensation related to these discoveries or developments.
Comply with the law
We will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we're complying with federal privacy law.
Respond to organ and tissue donation requests and work with a medical examiner or funeral director
Address workers' compensation, law enforcement, and other government requests
We can use or share health information about you:
Respond to lawsuits and legal actions
We can share health information about you in response to a court or administrative order, or in response to a subpoena.
Note: we do not create or manage a hospital directory, or maintain psychotherapy notes.
Certain kinds of medical information may receive enhanced privacy protection under federal or state law. This includes medical information that is:
We do not expect to maintain this type of sensitive medical information. If we do, we will disclose this type of sensitive medical information only with your prior written authorization or if permitted or authorized by law. The protection given to this type of sensitive medical information may depend upon the State in which you receive services or treatment.
Changes to the Terms of this Notice
We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available on our web site. You have the right to receive a paper copy of this Notice at any time. If you wish to do so, please contact our Privacy Official at email@example.com.